Intravenous leiomyomatosis: Case report and review of the literature / Leiomiomatosis intravenosa: a propósito de un caso y revisión de la literatura

Introduction: We retrospectively reviewed a case of a 42-year-old woman with intravenous leiomyomatosis. Clinical findings: The present study describes a case of IVL extending into the right internal and common iliac veins. Diagnosis: The patient was diagnosed by definitive pathological examination after a hysterectomy and double salpingectomy. Hypovolaemic shock due to delayed intraperitoneal bleeding from the ovarian vessels pedicle was observed. An emergent laparotomy for haemostasis was performed. A follow-up MRI, 2 months later, showed a polylobulated mass extending inside the right internal and common iliac veins. Intervention and result: The patient underwent a third laparotomic procedure with the removal of the right pelvic mass together with the involved veins. The postoperative course was uneventful, and the patient remains well at 3-month follow-up, with no signs of lower limb edema or venous disorders. Conclusion: Intracardiac leiomyomatosis is mostly diagnosed in premenopausal women. The most severe manifestation could be a vascular thrombosis or a right atrial tumor in the case of intracardiac involvement. Early and appropriate diagnosis is essential for optimal treatment. Surgery is the best treatment.(AU)

Introducción: Presentamos el caso de una paciente de 42 años con leiomiomatosis intravenosa. Hallazgos clínicos: El estudio presente describe un caso de IVL con afectación de las venas ilíaca común e interna derecha. Diagnóstico: La paciente fue diagnosticada mediante el examen histológico definitivo tras una histerectomía total con doble salpingectomía. Se objetivó un shock hipovolémico por sangrado intraperitoneal tardío del pedículo de vasos ováricos. Se realizó una laparotomía urgente para hemostasia. Una RMN durante el seguimiento, 2 meses después, mostró una masa polilobulada con afectación de la vena ilíaca común y la vena ilíaca interna derecha. Intervención y resultado: A la paciente se le realizó una tercera laparotomía con la extirpación de la masa pélvica derecha. El curso postoperatorio fue satisfactorio y la paciente permaneció asintomática a los 3 meses de seguimiento, sin signos de edema en extremidades inferiores ni otras afectaciones vasculares. Conclusión. La leiomiomatosis intracardíaca se diagnostica más frecuentemente en mujeres premenopáusicas. La forma de manifestación más severa sería una trombosis vascular o un tumor intracardíaco en la aurícula derecha, en el caso de afectación intracardíaca. Un diagnóstico precoz es esencial para un tratamiento óptimo. La cirugía es el mejor tratamiento.(AU)

Ordinal pattern transition networks in eye tracking reading signals.

Eye tracking is an emerging technology with a wide spectrum of applications, including non-invasive neurocognitive diagnosis. An advantage of the use of eye trackers is in the improved assessment of indirect latent information about several aspects of the subjects' neurophysiology. The path to uncover and take advantage of the meaning and implications of this information, however, is still in its very early stages. In this work, we apply ordinal patterns transition networks as a means to identify subjects with dyslexia in simple text reading experiments. We registered the tracking signal of the eye movements of several subjects (either normal or with diagnosed dyslexia). The evolution of the left-to-right movement over time was analyzed using ordinal patterns, and the transitions between patterns were analyzed and characterized. The relative frequencies of these transitions were used as feature descriptors, with which a classifier was trained. The classifier is able to distinguish typically developed vs dyslexic subjects with almost 100% accuracy only analyzing the relative frequency of the eye movement transition from one particular permutation pattern (plain left to right) to four other patterns including itself. This characterization helps understand differences in the underlying cognitive behavior of these two groups of subjects and also paves the way to several other potentially fruitful analyses applied to other neurocognitive conditions and tests.

Prediction of patients with idiopathic generalized epilepsy from healthy controls using machine learning from scalp EEG recordings.

Epilepsy detection is essential for patients with epilepsy and their families, as well as for researchers and medical staff. The use of electroencephalogram (EEG) as a tool to support the diagnosis of patients with epilepsy is fundamental. Today, machine learning (ML) techniques are widely applied in neuroscience. The main objective of our study is to differentiate patients with idiopathic generalized epilepsy from healthy controls by applying machine learning techniques on interictal electroencephalographic recordings. Our research predicts which patients have idiopathic generalized epilepsy from a scalp EEG study. In addition, this study focuses on using the extreme gradient boosting (XGB) method applied to scalp EEG. XGB is one of the variants of gradient boosting and is a supervised learning algorithm. This type of system is developed to increase performance and processing speed. Through this proposed method, an attempt is made to recognize patterns from scalp EEG recordings that would allow the detection of IGE with high accuracy and differentiate IGE patients from healthy controls, creating an additional tool to support clinicians in their decision-making. Among the ML methods applied, the proposed XGB method achieves a better prediction of the distinct features in EEG signals from patients with IGE. XGB was 6.26% more accurate than the k-Nearest Neighbours method and was more accurate than the support vector machine (10.61%), decision tree (9.71%) and Gaussian Naïve Bayes (11.83%). Besides, the proposed XGB method showed the highest area under the curve (AUC 98%) and balanced accuracy (98.13%) of all methods tested. Application of ML technique in EEG of patients with epilepsy is very recent and is emerging with promising results. In this research work, we showed the usefulness of ML techniques to identify and predict generalized epilepsy from healthy controls in scalp EEG studies. These findings could help develop automated tools that integrate these ML techniques to assist clinicians in differentiating between patients with IGE from healthy controls in daily practice.

Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study.

OBJECTIVE: The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators. DESIGN: Prospective descriptive multicenter cohort study. SETTING: 26 Intensive care units (ICU) from Andalusian region in Spain. PATIENTS OR PARTICIPANTS: Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30. INTERVENTIONS: None. VARIABLES: Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied. RESULTS: 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission <6.5%, and thrombocytopenia whereas the use of lopinavir/ritonavir was a protective factor. CONCLUSION: Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor.

Bottlenose dolphins (Tursiops truncatus) aggressive behavior towards other cetacean species in the western Mediterranean.

Aggressive behavior of bottlenose dolphins (Tursiops truncatus) towards conspecifics is widely described, but they have also often been reported attacking and killing harbour porpoises (Phocoena phocoena) around the world. However, very few reports exist of aggressive interactions between bottlenose dolphins and other cetacean species. Here, we provide the first evidence that bottlenose dolphins in the western Mediterranean exhibit aggressive behavior towards both striped dolphins (Stenella coeruleoalba) and Risso's dolphins (Grampus griseus). Necropsies and visual examination of stranded striped (14) and Risso's (2) dolphins showed numerous lesions (external rake marks and different bone fractures or internal organ damage by blunt trauma). Indicatively, these lessons matched the inter-tooth distance and features of bottlenose dolphins. In all instances, these traumatic interactions were presumed to be the leading cause of the death. We discuss how habitat changes, dietary shifts, and/or human colonization of marine areas may be promoting these interactions.

Predictive factors of six-week mortality in critically ill patients with SARS-CoV-2: A multicenter prospective study.

OBJECTIVE: The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators. DESIGN: Prospective descriptive multicenter cohort study. SETTING: 26 Intensive care units (ICU) from Andalusian region in Spain. PATIENTS OR PARTICIPANTS: Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30. INTERVENTIONS: None. VARIABLES: Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied. RESULTS: 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission <6.5%, and thrombocytopenia whereas the use of lopinavir/ritonavir was a protective factor. CONCLUSION: Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor.

Genome-wide association studies for sperm traits in Assaf sheep breed.

Sperm quality traits routinely collected by artificial insemination (AI) center for rams progeny test are related with the capacity to produce sperm doses for AI and, in more or less grade, with males' fertility. Low-quality ejaculates are unuseful to perform AI sperm doses, which suppose high economic loses for the AI center. Moreover, sperm quality traits have low heritability values which make traditional genetic selection little efficient to its improvement. In this work, a genome-wide association study (GWAS) was conducted by using sperm quality traits data and 50 K Affymetrix custom chip genotypes of 429 rams of Assaf breed from OVIGEN AI centre. Furthermore, 47 of these rams were also genotyped with the Illumina HD Ovine BeadChip, and therefore HD genotypes were imputed for all rams with phenotype data. Previous to the GWAS, a linear regression model was fitted including sperm traits as dependent variables; the flock of origin, date of sperm collection, and jump number as fixed effects; rams age at collection in months as covariate; and ram permanent effect as random. Pseudo-phenotypes obtained from this model were used as input for GWAS. Associations at the chromosome-wise level (FDR 10%) of 76 single-nucleotide polymorphisms (SNPs) in 4 chromosomes for ejaculate concentration (CON), 20 SNPs in 3 chromosomes for ejaculate volume (VOL), 32 SNPs in 1 chromosome for ejaculate number of spermatozoa (SPZ), and 23 SNPs for spermatozoa mass motility (MOT) in 17 chromosomes were found. Only SNPs associated with MOT overcame the genome-wide significance level. Some candidate genes for sperm traits variability were SLC9C1 (OAR1), TSN (OAR2), and FUT10 (OAR26) for MOT;. DOCK2, CPLANE1, SPEF2, and RAI14 (OAR16) for CON; SCAPER and PSMA4 (OAR18) for VOL; and PARM1 and LOC101110593 (OAR6) for SPZ. SNPs associated with sperm traits were not found to be correlated with milk production genetic variation; however, the high frequencies of some SNPs with negative effect over sperm traits found in animals at the top milk yield estimated breeding values (EBVs) ranking would allow to exert some selective presure to improve rams sperm performances. Effects and frequencies of some of the SNPs detected over sperm quality traits make these variants good candidates to be used in marker-assisted selection to improve sperm characteristics of Assaf rams and AI center efficiency to produce sperm doses.

Hydrocarbon Contamination Patterns in the Cenotes of the Mexican Caribbean: The Application of Principal Component Analysis.

Cenotes are naturally occurring flooded caves that are frequent in Mexico's Yucatan Peninsula; they result from the collapse of limestone bedrock into the regional groundwater table. Cenotes in Quintana Roo are important ecological and economic hot spots but are susceptible to anthropogenic pollution. In this study, we collected water samples from 11 cenotes over multiple years to evaluate polycyclic aromatic hydrocarbon (PAH) concentrations and patterns as associated with tourist traffic. The primary PAHs detected in samples included fluoranthene, anthracene, phenanthrene and naphthalene, with total PAH concentrations increasing almost fivefold for cenotes sampled from 2016 to 2017. This is compared to only a 7% increase in tourist traffic during these years. Multivariate statistical analysis of the PAH concentration data suggests that diesel, gasoline and asphalt are the most likely pollution sources and that they are associated with periods of increased tourist traffic.

Saccharification of water hyacinth biomass by a combination of steam explosion with enzymatic technologies for bioethanol production.

In the present work, bioethanol was produced by sugar fermentation obtained from water hyacinth using a novelty hybrid method composed of steam explosion and enzymatic hydrolysis, using hydrolytic enzymes produced by solid-state fermentation and water hyacinth as substrate. The highest activity, 42 U for xylanase and 2 U for cellulase per gram of dry matter, respectively, was obtained. Steam explosion pretreatment was performed at 190 â„ƒ for 1, 5, and 10 min, using water hyacinth sampled from the Maria Lizamba Lagoon, the Arroyo Hondo and the Amapa River. The highest amounts of reducing sugars of water hyacinth were obtained form the samples from the lagoon (5.4 g/50 g of dry matter) after 10 min of treatment. Steamed biomass was hydrolysed using the enzymes obtained by solid-state fermentation, obtained reducing sugars (maximum 15.5 g/L); the efficiency of enzymatic hydrolysis was 0.51 g of reducing sugars per gram of water hyacinth. Finally, reducing sugars were fermented using Saccharomyces cerevisiae for conversion to ethanol, with the highest ethanol concentration (7.13 g/L) and an ethanol yield of 0.23 g/g of dry matter.

Diagnostic benefits of adding EspC, EspF and Rv2348-B to the QuantiFERON Gold In-tube antigen combination.

Interferon (IFN)-γ release assays (IGRAs) are used to diagnose latent tuberculosis (TB) infection (LTBI). To improve the accuracy of these tests, different approaches, such as alternative cytokine detection and using different antigens, are considered. Following this purpose, this study aims to evaluate the addition of EspC, EspF and Rv2348-B to those present in the QuantiFERON-TB Gold In-Tube (QFN-G-IT). We included 115 subjects: 74 active TB patients, 17 LTBI individuals and 24 healthy controls. Whole blood samples were collected in QFN-G-IT and in-house tubes containing different combinations of EspC, EspF and Rv2348-B, together with ESAT-6, CFP-10, and TB7.7. After overnight incubation at 37 ºC, plasma was harvested and IFN-γ quantified. IFN-γ levels in the QFN-G-IT and in-house tubes correlated very good (Spearman Rho(r) > 0.86). In-house antigen combinations distinguished healthy individuals from those with active TB and LTBI (specificities and sensitivities higher than 87.5% and 96.3%, respectively [AUC > 0.938]). Adding EspC, EspF and Rv2348-B, increased the sensitivity of the test, being the addition of EspC and Rv2348-B the combination that yielded a higher sensitivity with no specificity loss. Addition of these antigens could improve diagnosis in patients with impaired or immature immune response who are at high risk of developing TB.

Effect assessment of reclaimed water and carbamazepine exposure on the thyroid axis of X. laevis: Apical and histological effects.

There is increasing environmental concern about the constant presence of pharmaceuticals and personal care products (PPCPs) in surface water, generally attributed to water discharge from wastewater treatment plants (WWTPs) that are unable to completely remove these compounds. The slight, but continuous, presence of these contaminants in reclaimed water (RW) poses a risk of chronic and sublethal toxicity, and the thyroid axis can likely be a target of many of these PPCPs. In this work, we addressed the effects of RW on the Xenopus laevis thyroid system. The Amphibian Metamorphosis Assay (AMA test) was used with modifications by exposing X. laevis tadpoles to RW samples, and to RW spiked with carbamazepine (CBZ) at 100 and 1000 higher than the average levels environmentally relevant (RW 100× and RW 1000×, respectively). Carbamazepine was selected because it is considered a marker of anthropogenic pollution and could have a potential effect on the thyroid axis. The morphological endpoints and histological alterations to the thyroid gland were evaluated. The results suggested the stimulation of the thyroid gland from exposures to the RW samples, supported by tadpoles' accelerated development and by the histological alterations observed in the thyroid gland. Developmental acceleration was also seen in the tadpoles exposed to the RW-100× and -1000× samples at comparable levels to those seen in exposures to RW samples alone. Hence CBZ did not seem to increase the effects of RW on the thyroid axis. Overall, our results suggested endocrine effects of these RW samples regardless of the CBZ concentration.

Bacillus spp. characterization and his intervention as a possible non-traditional etiology of chronic renal insufficiency in Tierra Blanca, Veracruz, Mexico.

Environmental, socioeconomic, educational, custom, occupation, and native pathogen microbiota factors have been identified as unique etiological factors by region for chronic renal insufficiency (CRI). In the region of Tierra Blanca, Veracruz, there is a significant incidence of CRI. The objective of this research was to identify the presence of the genus Bacillus spp. and its kinetic characterization for recognition as a possible non-traditional etiology of CRI in the region. The methodology included the isolation and morphological, biochemical, molecular and kinetic characterization of strains of the genus Bacillus spp. and an analysis of factors that indicate that their presence could affect the occupational health of the population, prompting cases of CRI. The presence of Bacillus cereus (pathogenic strain for humans) was established (biochemical identification, similarity 99%, by 16S rRNA gene) in sugarcane crops, mainly in the MEX-69-290 variety, with the higher growth rate and lower lag phase, compared to the other isolates. The strains are reported as a potential danger of direct infection and a risk factor for the indirect development of CRI, in the non-traditional cause modality, in the sugarcane fields. It is recommended that committed actions be undertaken to protect and promote the health of the population.

A Review of the Latest Recommendations on the Management of Chronic Urticaria: A Multidisciplinary Consensus Statement from Andalusia, Spain. / Revisión de las últimas novedades en el manejo del paciente con urticaria crónica: Consenso multidisciplinar de la comunidad autónoma de Andalucía.

Chronic urticaria is a difficult-to-treat skin disorder that has a major impact on patient quality of life. The latest update of the European guideline on the management of urticaria was published in 2018. In this consensus statement, produced in the autonomous community of Andalusia, Spain, we describe a multidisciplinary approach for applying the new treatment algorithm proposed by the European guideline in our region.

Diesel uptake by an indigenous microbial consortium isolated from sediments of the Southern Gulf of Mexico: Emulsion characterisation.

In this study a microbial consortium, dominated by members of the genera Marinobacter and Alcanivorax (Gammaproteobacteria) isolated from marine sediments of Southern Gulf of Mexico, was assessed to grow in a bubble column bioreactor using 13 g L-1 of diesel (aliphatic and aromatic hydrocarbons mix including nonane and hexadecane) as the sole carbon source. The consortium was able to produce 3.3 g L-1 of biomass, measured as suspended solids. Microbial growth was detectable, even substrate depletion, after 8 days of cultivation. The emulsifier activity and its influence on the droplet size were also evaluated: it was observed that droplet diameter decreases as emulsifier activity increases. The bubble column bioreactor system proposed in this research could be used as a biotechnological process for the remediation of a contaminated body in important petrochemical regions, for example, Veracruz, México, where some points of sea and fresh-water bodies were analysed to find nonane and hexadecane in all sample water. It is important due to a lack of information, regarding hydrocarbon pollution in this port area, is filled.

Use of IP-10 detection in dried plasma spots for latent tuberculosis infection diagnosis in contacts via mail.

The aim of this study was to test the use of IP-10 detection in dried plasma from contact studies individuals (contacts of smear positive patients), by comparing it with IP-10 and IFN-γ detection in direct plasma, to establish IP-10 detection in DPS as a useful assay for LTBI diagnosis. Whole blood samples were collected from 80 subjects: 12 with active tuberculosis (TB), and 68 from contact studies. The amount of IFN-γ produced by sensitized T cells was determined in direct plasma by QuantiFERON Gold In-Tube test. IP-10 levels were determined in direct and dried plasma by an in-house ELISA. For dried plasma IP-10 determination, two 25 µl plasma drops were dried in Whatman903 filter paper and sent by mail to the laboratory. Regarding TB patients, 100.0%, 91.7% and 75.0% were positive for IFN-γ detection and IP-10 detection in direct and dried plasma, respectively. In contacts, 69.1%, 60.3% and 48.5% had positive results after IFN-γ and IP-10 in direct and dried plasma, respectively. The agreement among in vitro tests was substantial and IP-10 levels in direct and dried plasma were strongly correlated (r = 0.897). In conclusion, IP-10 detection in dried plasma is a simple and safe method that would help improve LTBI management.

Effect of CRHR1 and CRHR2 gene polymorphisms and childhood trauma in suicide attempt.

Family, twin, and adoption studies have suggested that genetic factors might be involved in suicidal behavior. Corticotropin-releasing receptor type 1 (CRHR1) and 2 (CRHR2) genes play a key role in the activation and modulation of the hypothalamic-pituitary-adrenal (HPA) axis, which is considered a major stress regulator. Childhood trauma is an environmental risk factor associated with suicide attempt (SA) and it has been related to HPA axis dysregulation. This study aimed at analyzing the relationship of CRHR1 and CRHR2 genes with childhood trauma concerning the development of SA. In this study, we included 366 affective disorder patients. Among them, 183 patients had SA at least once and 183 had not SA. Information regarding SA and childhood trauma was obtained from medical records. Multifactor Dimensionality Reduction program was used to detect gene-environment interactions between CRHR1 (rs110402, rs242924, and rs16940665) and CRHR2 (rs2190242, rs2284217, and rs2014663) with childhood trauma in SA. The analysis showed an interaction of CRHR1 and CRHR2 with childhood trauma, thus conferring increased risk of having presented at least one SA (OR 7.44; 95% CI 4.58-12.07; p < 0.0001). In addition, we observed the following in the trauma subtypes analysis: physical negligence (OR 4.72; 95% CI 3.01-7.40; p < 0.0001), emotional abuse (OR 5.76; 95% CI 3.67-9.05; p < 0.0001), and sexual abuse (OR 5.70; 95% CI 3.62-8.97; p < 0.0001). Our results suggested that genetic variants of CRHR1 and CRHR2 genes in addition to physical negligence, and emotional and sexual abuse, contribute to increase risk of presented at least one SA.

[Ten years' experience with vagus nerve stimulation in a paediatric population]. / Diez años de experiencia con el estimulador del nervio vago en una poblacion pediatrica.

INTRODUCTION: Fifty million people are affected by epilepsy. Up to 30% are not controlled with the aid of antiepileptic drugs. The vagus nerve stimulator (VNS) is a therapeutic alternative that must be taken into account. AIMS: To determine the effect of the VNS in a cohort of paediatric patients with refractory epilepsy. PATIENTS AND METHODS: A retrospective study of children with a VNS implanted between 2008 and 2017 in a tertiary hospital. Epidemiological, aetiological, clinical and electrophysiological data, along with VNS parameters were analysed. RESULTS: The study included 35 patients, with a mean age when the VNS was implanted of 12.84 years (range: 3.1-18.7 years) and a mean time between onset of epilepsy and implantation of 7.2 years (range: 1.3-17.7 years). The causation was structural in 62.9% of cases. The most frequent epileptic conditions were: Lennox-Gastaut syndrome and focal epilepsy, with a predominance of tonic seizures (57.1%). The video electroencephalogram showed multifocal anomalies (54%) and a pattern of epileptic encephalopathies (34.3%). Intellectual disability was associated in 94% of the cases. The mean of previous antiepileptic drugs was 9.6 ± 3 (range: 4-16). 43% responded to treatment (>= 50% reduction in number of seizures), with a mean reduction of 67.3%, which improved with higher ages of onset of epilepsy. Three patients were seizure-free (8.5%). The number of seizures decreased by 33% at six months and by 47.4% at 24 months. There was also a notable degree of cognitive (57%) and behavioural improvement (53%). In 28% of cases there were some side effects, but in general they were mild. CONCLUSIONS: The VNS is a valid option in refractory epilepsy, with improvements not only in terms of seizures but also regarding cognitive-behavioural aspects, this being very important for the paediatric population.

TITLE: Diez años de experiencia con el estimulador del nervio vago en una poblacion pediatrica.Introduccion. La epilepsia afecta a 50 millones de personas. Hasta un 30% no se controla con farmacos antiepilepticos. El estimulador del nervio vago (ENV) constituye una alternativa terapeutica que hay que valorar. Objetivo. Determinar el efecto del ENV en una cohorte pediatrica con epilepsia refractaria. Pacientes y metodos. Estudio retrospectivo de niños con ENV implantado entre 2008 y 2017 en un hospital terciario. Se han analizado datos epidemiologicos, etiologicos, clinicos, electrofisiologicos y parametros del ENV. Resultados. Se incluyo a 35 pacientes, con una mediana de edad de implantacion de 12,84 años (rango: 3,1-18,7 años) y una mediana de evolucion entre el inicio de la epilepsia y la implantacion de 7,2 años (rango: 1,3-17,7 años). La etiologia fue estructural en el 62,9% de los casos. Cuadros epilepticos mas frecuentes: sindrome de Lennox-Gastaut y epilepsia focal, con predominio de las crisis tonicas (57,1%). El videoelectroencefalograma mostro anomalias multifocales (54%) y un patron de encefalopatia epileptica (34,3%). El 94% asociaba discapacidad intelectual. La media de farmacos antiepilepticos previos fue de 9,6 ± 3 (rango: 4-16). El 43% fueron respondedores (>= 50% reduccion de crisis), con una media de reduccion del 67,3%, mejor cuanto mayor era la edad de inicio de la epilepsia. Tres pacientes quedaron libres de crisis (8,5%). La reduccion de crisis fue del 33% a los 6 meses y del 47,4% a los 24 meses. Mejoria cognitiva (57%) y conductual (53%). El 28% tuvo efectos secundarios, generalmente leves. Conclusiones. El ENV es una opcion valida en la epilepsia refractaria con mejoria no solo de las crisis, sino tambien cognitiva y conductual, con la importancia que ello tiene para la poblacion pediatrica.

Hydrocarbon water-pollution related to chronic kidney disease in Tierra Blanca, a perfect storm.

Chronic kidney disease (CKD) affects the kidneys, and in severe cases is considered as end-stage renal disease which can only be treated by dialysis and transplantation. Tierra Blanca city has a higher CKD rate compared to other Mexican cities, but its principal cause has not been found yet. Main factors related to CKD are carbonated beverage consumption, diabetes, obesity, hypertension, heat stress, dehydration, and intoxication by pesticides, heavy metals, and/or hydrocarbons. The aim of this work was to evaluate hydrocarbon pollution in Tierra Blanca domestic fresh-water related to CKD and to integrate this information with other main factors in order to suggest precautionary actions taking account of key actors. We found hydrocarbons in the water wells of the city and the presence of other risk factors, which creates a perfect storm for CKD. Additionally, key actors were identified in order to follow precautionary principles related to CKD cases in Tierra Blanca.